Department of Anesthesiology & Perioperative Care: School of Medicine: University of California, Irvine

Perioperative Surgical Home (PSH)

The Perioperative Surgical Home (PSH) is a perioperative model that achieves a better value for patients through care coordination led by anesthesiologists. This model is the counterpart to the medical home model and is particularly effective in managing health care expenses while providing better clinical care.

Drs. with paitent for pre-op

Approximately 60 percent to 70 percent of a traditional hospital’s expenses are associated with surgical and procedural (perioperative) care.

The UC Irvine Department of Anesthesiology & Perioperative Care believes that there is substantial opportunity to reduce overall health care costs and provide high quality clinical care through improved coordination of surgical and procedural care.

Reducing Overall Healthcare Costs

How would a 'Perioperative Surgical Home' reduce overall health care costs?

  • Partnering with hospitals and surgeons to determine cost-effective implants and pharmaceuticals
  • Decreasing the number of tests and consults through preoperative evaluations performed by Pre-Anesthesia Testing (PAT) clinics
  • Managing the selection of appropriate candidates for surgery
  • Reducing the rate of complications such as postoperative nausea and vomiting, which increase length of stay or necessitate admission following outpatient surgery

For those situations where multiple pathways of care are available, anesthesiologists play a central role in helping patients determine the most appropriate course of care.

Pre-op evaluation being preformed.Evidence based Cost Utility Analysis can play a role in informing the patient’s decision making. Additional shared savings would be derived from decreased testing and consultations, through preoperative evaluations performed in anesthesiologist run Pre-Anesthesia Testing (PAT) units, known at UC Irvine Health as our Comprehensive Patient Care (CPC) unit, as well as reduced hospital lengths of stay and hospital readmissions from:

  • Selection of appropriate candidates for surgery, including interventions, with those who are highly unlikely to benefit
  • Identification of optimal timing for surgical interventions to avoid rescheduling
  • Reductions of complications, such as surgical or catheter related infections, poor perioperative glycemic control, and postoperative nausea and vomiting, that increase length of stay or necessitate admission following outpatient surgery
  • Improved perioperative management of pain and anxiety to ensure the best possible patient care experience

Saving that may accrue due to the above-mentioned strategies and care coordination is directly attributable to the participation of the anesthesiologist in this process.

Anesthesiologists' Leadership Role

Pre-op evaluation being preformed.Anesthesiologists routinely interact with providers from virtually all care settings and assess and monitor the patient from an overall perioperative perspective; thus, anesthesiologists are ideally suited to effectively assess and manage risk across the full continuum of the perioperative setting.

Anesthesiologists partner with hospitals, proceduralists and surgeons in selecting cost-effective implants and pharmaceuticals to provide better quality of care at lower a lower cost.

In addition, anesthesiologists serve as physician managers and coordinators of operating and procedure rooms.

In addition to managing patient flow and triage through the surgical experience anesthesiologists evaluate and help optimize patients for their proposed operative procedures.

Lastly, the expertise of your anesthesiologist will help guide you through your immediate postoperative period. By managing your care to keep you comfortable and relaxed you will be prepared to heal in as optimal a manner as possible.

“The ASA recommends that performance measures for anesthesiologists focus on improving safety and coordinating perioperative care. The following can be used to direct measure development: patient surgeries accomplished safely, surgeries accomplished under anesthesiologists’ direction, and perioperative care that includes evaluations from anesthesiologists and following of anesthetic plans.”

To that effect, ASA strongly promotes the concept of a coordinated perioperative or surgical home model in order to achieve better value for beneficiaries through care coordination and process improvements led by anesthesiologists.

Anesthesiologist’s engagement is critical to achieving the goals of reducing health care costs and improving quality of care.
- American Society of Anesthesiologists

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